Pathological features of connective tissue disease-associated interstitial lung disease in transbronchial cryobiopsies.

IF 3.9 2区 医学 Q2 CELL BIOLOGY
Histopathology Pub Date : 2024-09-02 DOI:10.1111/his.15311
Andrew Churg, Venerino Poletti, Claudia Ravaglia, Radoslav Matej, Martina Koziar Vasakova, Helena Hornychova, Brian Stewart, Divya Patel, Ernesto Duarte, Diana C Gomez Manjarres, Hiren J Mehta, Laszlo T Vaszar, Henry Tazelaar, Joanne L Wright
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Abstract

Aim: Transbronchial cryobiopsies are increasingly used for the diagnosis of interstitial lung disease (ILD), but there is a lack of published information on the features of specific ILD in cryobiopsies. Here we attempt to provide pathological guidelines for separating usual interstitial pneumonia (UIP) of idiopathic pulmonary fibrosis (IPF), fibrotic hypersensitivity pneumonitis (FHP) and connective tissue disease-associated ILD (CTD-ILD) in cryobiopsies.

Methods: We examined 120 cryobiopsies from patients with multidisciplinary discussion (MDD)-established CTD-ILD and compared them to a prior series of 121 biopsies from patients with MDD-established IPF or FHP.

Results: A non-specific interstitial pneumonia (NSIP) pattern alone was seen in 36 of 120 (30%) CTD-ILD, three of 83 (3.6%) FHP and two of 38 (5.2%) IPF cases, statistically favouring a diagnosis of CTD-ILD. The combination of NSIP + OP was present in 29 of 120 (24%) CTD-ILD, two of 83 (2.4%) FHP and none of 38 (0%) IPF cases, favouring a diagnosis of CTD-ILD. A UIP pattern, defined as fibroblast foci plus any of patchy old fibrosis/fibrosis with architectural distortion/honeycombing, was identified in 28 of 120 (23%) CTD-ILD, 45 of 83 (54%) FHP and 27 of 38 (71%) IPF cases and supported a diagnosis of FHP or IPF. The number of lymphoid aggregates/mm2 and fibroblast foci/mm2 was not different in IPF, CTD-ILD or FHP cases with a UIP pattern. Interstitial giant cells supported a diagnosis of FHP or CTD-ILD over IPF, but were infrequent.

Conclusions: In the correct clinical/radiological context the pathological findings of NSIP, and particularly NSIP plus OP, favour a diagnosis of CTD-ILD in a cryobiopsy, but CTD-ILD with a UIP pattern, FHP with a UIP pattern and IPF generally cannot be distinguished.

经支气管冷冻生物切片中结缔组织病相关间质性肺病的病理特征。
目的:经支气管冷冻活组织检查越来越多地用于间质性肺病(ILD)的诊断,但目前还缺乏有关冷冻活组织检查中特定 ILD 特征的公开信息。在此,我们试图为冷冻活检中特发性肺纤维化(IPF)、纤维化超敏性肺炎(FHP)和结缔组织病相关 ILD(CTD-ILD)的常见间质性肺炎(UIP)的分离提供病理学指南:我们对120例经多学科讨论(MDD)确诊的CTD-ILD患者的冷冻活组织切片进行了检查,并将其与之前121例经MDD确诊的IPF或FHP患者的活组织切片进行了比较:120例CTD-ILD中的36例(30%)、83例FHP中的3例(3.6%)和38例IPF中的2例(5.2%)单独出现了非特异性间质性肺炎(NSIP)模式,从统计学角度来看,这有利于CTD-ILD的诊断。120例CTD-ILD病例中有29例(24%)、83例FHP病例中有2例(2.4%)和38例IPF病例中有2例(0%)出现NSIP+OP组合,这有利于CTD-ILD的诊断。在120例CTD-ILD中的28例(23%)、83例FHP中的45例(54%)和38例IPF中的27例(71%)中发现了UIP模式,其定义为成纤维细胞灶加上任何斑块状陈旧性纤维化/纤维化,伴有结构变形/蜂窝状,支持FHP或IPF的诊断。在具有UIP模式的IPF、CTD-ILD或FHP病例中,淋巴细胞聚集数/mm2和成纤维细胞灶数/mm2没有差异。间质巨细胞支持 FHP 或 CTD-ILD 的诊断,而非 IPF,但并不常见:结论:在正确的临床/放射学背景下,NSIP的病理结果,尤其是NSIP加OP的病理结果,有利于冷冻活检中CTD-ILD的诊断,但具有UIP模式的CTD-ILD、具有UIP模式的FHP和IPF一般无法区分。
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来源期刊
Histopathology
Histopathology 医学-病理学
CiteScore
10.20
自引率
4.70%
发文量
239
审稿时长
1 months
期刊介绍: Histopathology is an international journal intended to be of practical value to surgical and diagnostic histopathologists, and to investigators of human disease who employ histopathological methods. Our primary purpose is to publish advances in pathology, in particular those applicable to clinical practice and contributing to the better understanding of human disease.
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